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TUBERCULOSIS IN LONDON.
Report by Dr. F. N. Kay Menzies on the Arrangements for the Treatment of
Tuberculosis in London.
I—Introduction.
Tuberculosis is the most prevalent and widely spread of all the Important diseases in this country.
The subjoined tabular statement gives an impression, though a very limited one, of the havoc which it
plays annually with the health of the community.

* Including non.civilian deaths—In 1917 these numbered 961 pulmonary and 212 other tuberculosis.
Note.—The figures for 1915 onwards relate to civilians only (except those for England and Wales in 1918).

It will be observed that it accounts for the deaths of between 50,000 and 60,000 persons each year
in England and Wales, and of these London alone accounts for more than 8,000 persons. Terrible as is
this death roll, year by year, it takes no account of the many scores of thousands more who are victims
of the disease at some stage short of death. To get even an approximate idea of the number of persons
in England and Wales who are suffering from tuberculosis is, for many reasons, a very difficult matter,
but if we take as a basis for calculation the number of primary notifications in a year and multiply
that number by five (on the broad assumption that the life of a tuberculous patient is about five
years from the onset of the first definite symptoms of the disease) we reach the figure of about 450,000 to
500,000 as a very rough estimate of the number of persons (of all ages and at all stages) who at any given
moment have been definitely recognised as suffering from this disease. For London alone this would mean
about 70,000 to 80,000 cases. The probability is that these figures really represent a considerable
under.estimate of the actual facts if they could be precisely ascertained. Both in Scotland and Ireland
the incidence of the disease is greater, while the figures obtainable before the war for Germany, Austria,
Hungary, the Balkan Countries and various other countries of Europe are still higher. On the other
hand it is interesting to note that Belgium was, at all events in pre.war years, an exception to this
rule—the incidence for that country being lower than for England and Wales. It is a notorious fact now
that during the progress of the war there was an enormous increase in the incidence of and deaths
from tuberculosis in all the Enemy countries (Appendix I.).
The following extract from an address by Sir Robert Philip to the Glasgow Southern Medical
Society in 1913, gives a very clear account of the progress of the disease in the human body.
" Tuberculosis is an infective disease due to inoculation with the tubercle bacillus. Let
us go a step further, and here the analogy with syphilis will prove helpful. Tuberculos a is
induced, like syphilis, through the entrance into the system of the specific organism. The
point of entrance may be theoretically anywhere—either a cutaneous or mucous surface. Both
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